Cancer prehabilitation uses a multidisciplinary approach combining exercise, nutrition and psychological strategies to prepare patients for the challenges of cancer treatment such as surgery, chemotherapy and radiation therapy.

Evidence indicates that prehabilitating newly diagnosed patients with cancer before starting treatment can be beneficial. This may include conducting a physical and psychological assessment to establish a baseline function level, identifying impairments and providing targeted interventions to improve the patient’s health, thereby reducing the incidence and severity of current and future impairments related to cancer and its treatment (Silver & Baima 2013).

The process of prehabilitation for this complex group should be highly integrated with the treating surgical/medical team. Patients requiring amputation will benefit from preamputation counselling and comprehensive preoperative pain management to reduce the risk of phantom pain.

Medications should be reviewed at this point to ensure optimisation and to improve adherence to medicines used for comorbid conditions.

Screening with a validated screening tool (for example, the National Comprehensive Cancer Network Distress Thermometer and Problem Checklist), assessment and referral to appropriate health professionals or organisations is required to meet the identified needs of an individual, their carer and family.

In addition to the other common issues outlined in the Appendix, specific needs that may arise at this time include the following.

Physical

• Change in functional abilities – patients may benefit from referral to occupational therapy, physiotherapy and/or exercise physiology.
• Patient may need treatment for other physical symptoms such as pain, fatigue and musculoskeletal dysfunction.
• Patients require ongoing nutritional screening, assessment and management. Reduced oral intake and/or swallowing difficulties and weight loss require referral to a dietitian and speech pathologist (for swallowing difficulties).

Psychological

• Patients may require help with psychological and emotional distress while adjusting to the diagnosis, treatment phobias, existential concerns, stress, difficulties making treatment decisions, anxiety/depression, psychosexual issues such as potential loss of fertility, loss of previous life roles and interpersonal problems.

Social/practical

• Patients may need support to attend appointments.
• Provide guidance about financial and employment issues (such as loss of income and having to deal with travel and accommodation requirements for rural patients and caring arrangements for other family members).

Information

• Discuss fertility options with the patient and/or family (where appropriate) before beginning treatment.
• Provide appropriate information for people from culturally and linguistically diverse backgrounds.

Spiritual needs

• Patients and their families should have access to spiritual support that is appropriate to their needs throughout the cancer journey.

The lead clinician should:

• establish if the patient has a regular or preferred general practitioner
• provide contact details of a key contact for the patient
• discuss a timeframe for diagnosis and treatment with the patient and carer
• discuss the option of fertility preservation (referral to a fertility service for counselling and evaluation of options may be appropriate)
• discuss the benefits of multidisciplinary care and make the patient aware that their health information will be available to the team for discussion at the multidisciplinary team meeting
• offer individualised sarcoma information that meets the needs of the patient and carer (this may involve advice from health professionals as well as written and visual resources)
• offer advice on how to access information and support from websites, community and national cancer services and support groups for both patients and carers
• refer the patient to the What to Expect – Sarcoma (bone and soft tissue tumours) guide.
• use a professionally trained interpreter to communicate with people from culturally or linguistically diverse backgrounds including Aboriginal and Torres Strait Islander people.

The lead clinician should:

• ensure regular and timely (within a week) communication with the person’s general practitioner regarding the treatment plan and recommendations from multidisciplinary team meetings
• notify the general practitioner and family/carer if the person does not attend clinic appointments
• gather information from the general practitioner including their perspective on the person (psychological issues, social issues and comorbidities) and locally available support services
• help develop a chronic disease and mental healthcare plan as required
• discuss shared care arrangements (with general practitioners and/or regional cancer specialists)
• invite the general practitioner to participate in multidisciplinary team meetings (consider using video- or teleconferencing).